ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

4. Patient assessment and history review at the time of the test 5. A resting supine standard 12-lead ECG should be obtained before exercise to compare to previously obtained ECGs to determine if changes have occurred over time (13). This should be followed by a stand- ing or sitting (if using cycle) ECG with limb electrodes on the trunk of the body to minimize motion and muscle artifact during exercise. 6. ECG electrode placement 6.1. The modified 10-electrode (Mason-Likar) configuration is the preferred method of electrode place- ment for obtaining a 12-lead ECG (20, 23, 27). 1. The positions of the precordial leads are in the standard locations. The right arm (RA) and left arm (LA) limb electrodes are usually placed slightly below the right and left clavicle. The right leg (RL) and left leg (LL) limb electrodes are usually placed at the lower edge of the rib cage, or alternatively, at the level of the umbilicus at the mid-clavicular line. 6.2. Skin preparation is essential to reduce surface resistance and ensure a good ECG signal (20, 23). 1. Shave hair in the areas of the electrode application, when applicable. 2. Use alcohol wipe to remove surface oils. 3. Abrade skin with fine emery cloth (240 grit sandpaper or mechanical skin preparation device). There are commercially available skin preps which include an abrasive and alcohol. 7. If arterial blood gases are indicated, arterial line placement to obtain multiple arterial blood samples may be required to fully assess gas exchange (2, 3). Alternately, in some situations, a single arterial blood sample may be taken during heavy exercise by radial artery puncture. 8. Pulmonary function tests 8.1. Obtain pre-exercise spirometry, including maximum voluntary ventilation (MVV). The results of this test can be used for: 1. Determining ventilatory capacity and therefore breathing reserve for assessing ventilatory limitations (3, 28) 2. The assessment of airway function pre- and post-exercise (although it appears that the incre- mental exercise protocol used for CPET is less sensitive than a constant work protocol for the detection of exercise-induced bronchoconstriction) (29)

8.2.

Results from other PF tests such as Dl CO

will help determine which outcome measures are most ap-

propriate.

9.

Pulse oximetry 9.1.

Prepare probe site according to manufacturer’s instructions.

9.2. Ensure a good baseline reading for any probe by noting that the instrument indicates an adequate signal, pulsing with the heartbeat, and that heart rate measured by pulse oximeter agrees with ECG readings.

Patient Assessment and History 1.

The patient’s medical history, clinical diagnosis, and reason for the test should be reviewed by a physician or trained professional. A questionnaire can aid this process (example in Appendix 19.1) and would likely include asking about: 1.1. Current medications (e.g., bronchodilator, medications for control of blood pressure, and beta- blockers)

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